Congress is asking the CMS to be flexible as it moves to eliminate Medicare payments for services provided at new off-campus outpatient departments. Lawmakers say hospitals may have good reasons to relocate facilities.
The rule would affect off-campus facilities that came into operation after Nov. 2, 2015. Beginning next year, payments would flow to physicians, making it difficult for health systems to recoup capital or operational costs for the facilities, even though they are responsible for continuing to equip and maintain the off-campus offices.
A bipartisan group of 51 U.S. senators and more than 200 U.S. congressmen wrote two letters asking for some tweaks to the rule before its finalized and said the CMS ignored them when they made similar suggestions in comments made months prior to the July release of the proposed rule.
"We strongly believe numerous areas need more flexibility to ensure patients have continued access to care, and we urge changes in the final rule to protect our constituents who are Medicare patients," the letter stated.
The letters ask that recently relocated off-site facilities be protected from the rule. They stated that a hospital may move a facility because of environmental issues such as being located on an earthquake fault line or a flood plain, having a lease expire, becoming obsolete or damaged or becoming too small because of population shifts and increased patient loads.
Lawmakers also stressed that the CMS should show some flexibility on a provision that stressed only off-campus departments that are within 250 yards of a hospital's main buildings would continue to be reimbursed.
A strict interpretation of the 250-yard criterion would affect hospitals that have natural or man-made barriers on their campuses including rivers, wetlands and highways; those located in densely populated urban areas; or those located on landlocked university campuses, lawmakers said.
In these instances they urge the CMS to instruct its regional offices to use the rule of “reasonable proximity” when making on-campus determinations and to evaluate on-campus status within the context of the hospital and its surrounding geography.
The letters come just weeks after the American Hospital Association asked CMS to delay implementation of the payment reduction for at least one year. It says the proposal in its current form could make providers vulnerable to violating anti-kickback laws since there is nothing in the proposal that spells out how a hospital is supposed to be paid for its overhead expenses if all of the reimbursement goes to the physician.
But the CMS is motivated to make the change. The agency's actuary has estimated that site-neutral payments for ambulatory care would save Medicare about $500 million in 2017.
The CMS said that it is taking all stakeholder feedback into consideration before issuing its final rule. That's expected to come in early November, giving hospitals just two months to come up with new, complex agreements with physicians in order to comply with the rule.
